Post-surgical complications in patients with bladder cancer treated with cystectomy: Differences between open and laparoscopic approach

Subirá-Ríos, D.; Herranz-Amo, F.; Moralejo-Gárate, M.; Caño-Velasco, J.; Renedo-Villar, T.; Bernardos, G. Barbas; Bueno-Chomón, G.; Rodríguez-Fernández, E.; Hernández-Fernández, C.

doi:10.1016/j.acuroe.2019.05.001

Cited by 4 publications

(3 citation statements)

References 18 publications

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“…There was an overall trend towards lower estimated blood loss and lower transfusion rate in LRC group, which is consistent with other studies [ 7 , 8 , 14 ], but this was statistically nonsignificant ( P =0.119 and P =0.207, respectively). Additionally the rate of transfusion of more than 1 unit of RBCs was higher in the open cystectomy group (11 cases vs. 4 cases).…”

Section: Discussionsupporting

confidence: 91%

Randomized Controlled Trial of Laparoscopic versus Open Radical Cystectomy in a Laparoscopic Naïve Center

Fadlalla

Hanafy

Abdelhakim

et al. 2021

Advances in Urology

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Background. Laparoscopic radical cystectomy is a challenging surgical procedure; however, it has been largely abandoned in favor of the more intuitive robotic-assisted cystectomy. Due to the prohibitive cost of robotic surgery, the adoption of laparoscopic cystectomy is of relevance in low-resource institutes. Methodology. This is a randomized controlled trial comparing laparoscopic radical cystectomy (LRC) to open radical cystectomy (ORC) at a single institute. Each group included thirty patients. The trial was designed to compare both approaches regarding operative time, blood loss, transfusion requirements, length of hospital stay, time to oral intake, requirement of opioid analgesia, and complications. Results. LRC was associated with less hospital stay (9.8 vs. 13.8 days, P = 0.001 ), less time to oral solid intake (6 vs. 8.6 days, P = 0.031 ), and lower opioid requirements (23.3% vs. 53.3%, P = 0.033 ). There was a trend towards lower blood loss and transfusion requirements, but this did not reach statistical significance. Overall complication rates were comparable. Conclusion. Laparoscopic radical cystectomy was associated with comparable postoperative outcomes when compared to ORC in the first laparoscopic cystectomy experience in our center. Benefitting from the assistance of an experienced laparoscopic surgeon is recommended to shorten the learning curve.

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Section: Discussionsupporting

confidence: 91%

Randomized Controlled Trial of Laparoscopic versus Open Radical Cystectomy in a Laparoscopic Naïve Center

Fadlalla

Hanafy

Abdelhakim

et al. 2021

Advances in Urology

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“…C-reactive protein (CRP) and procalcitonin are released by IL-6, which stimulates hepatic acute-phase protein synthesis. The amount of IL-6 secreted correlates with the severity of the trauma, the length of surgery, and the risk of postoperative complications [12][13][14][21][22][23][24][25][26].…”

Section: Results and Dissectionmentioning

confidence: 99%

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2021

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Laparoscopy is a minimally invasive surgery using advanced technology, so the resulting surgical wound is smaller than conventional surgery. Laparoscopy, especially in the field of urology, is known to cause complications in patients. Intraoperative complications will cause physiological stress that causes an inflammatory response in the body. Neutrophils are one of the most important cells in producing the inflammatory response in the acute phase. Meanwhile, lymphocytes are the main cellular components of the immune system that are mediated by T cells and humoral cells. This study was conducted retrospectively and reviewed the patient's medical record data from intraoperative to outpatient admission. The sample included 71 patients who underwent laparoscopic urology in 2017-2019. There was a difference in NLR values between pre surgery and post-surgery (p <0.05). It is known that the postoperative NLR value is higher than preoperative. In addition, it was known that there were differences in postoperative NLR values between patients who did not experience complications and those who had complications (p < 0.05). Where there is an increase in the postoperative NLR value in patients with complications, intraoperative complications lead to increased NLR. The greater the physiological stress experienced, the higher the NLR value. Increased NLR reflects poor output.

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“…In recent years, the incidence and mortality of bladder cancer have increased significantly [1], ORC is the gold standard for muscle or non-muscle invasive bladder cancer [2]. However, its bleeding volume, operating time, the length of hospital stay and complications are significantly higher than MIRC [3,4].…”

Section: Introductionmentioning

confidence: 99%

Bayesian network analysis of open, laparoscopic and Robot-assisted Radical cystectomy.

Lin¹,

Chen²,

Hu³

et al. 2020

Preprint

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Background We performed the conventional meta-analysis and network meta-analysis to evaluate the safety and efficacy of Robot-assisted Radical cystectomy (RARC) versus laparoscopic radical cystectomy (LRC) versus open radical cystectomy (ORC) for bladder cancer (BCa). Methods A systematic search of PubMed, Cochrane Library and Embase was performed up to until Dec 20, 2019. Outcome indexes include: oncologic outcomes: the recurrence rate, mortality; pathologic outcomes: Lymph node yield (LNY), Positive lymph node (PLN), positive surgical margins (PSM); perioperative outcomes: operating time (OP), estimated blood loss (EBL), blood transfusion rate, the length of hospital stay, and the time to regular diet. And Postoperative 90-day complications. Results 59 articles describing 8 RCTs, 25 Prospective study, 26 Retrospective study (6944 patients) were analyzed. No significant differences were found between RARC, LEC and ORC in two oncologic outcomes: the recurrence rate and mortality. However, for the recurrence rate, patients with LRC has the highest probability, ORC has the second highest probability, and RARC has the lowest probability. For the mortality, patients with ORC has the highest probability, LRC has the second probability, and RARC has the lowest probability. In three pathologic outcomes: direct meta-analysis indicates that ORC is more than RARC or LRC in PSM and RARC is more than ORC in LNY. On the other hand, network meta-analysis indicates that ORC is more than RARC in PSM. No significant differences were found between RARC, LEC and ORC in other pathologic outcomes: LNY and PLN. for LNY, patients with RARC has the highest probability, ORC has the second highest probability, and LRC has the lowest probability by our network meta-analysis. For PLN, patients with ORC has the highest probability, LRC has the second probability, and RARC has the lowest probability by our network meta-analysis. With respect to perioperative outcomes, direct meta-analysis indicates that RARC is shorter time than LRC or ORC in OP. On the other hand, network meta-analysis indicates that patients with ORC have significantly longer OP than LRC or RARC. Direct meta-analysis and network meta-analysis both indicate that ORC is more than RARC or LRC in EBL, ORC is longer than RARC or LRCConclusion The conventional meta-analysis and network meta-analysis suggest that RARC is a safest and most effective surgical approach in the treatment of BCa and LRC rankes second. However, large sample size and more high-quality studies are still needed to further improve and verify.

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Post-surgical complications in patients with bladder cancer treated with cystectomy: Differences between open and laparoscopic approach

Cited by 4 publications

References 18 publications

Randomized Controlled Trial of Laparoscopic versus Open Radical Cystectomy in a Laparoscopic Naïve Center

Randomized Controlled Trial of Laparoscopic versus Open Radical Cystectomy in a Laparoscopic Naïve Center

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Bayesian network analysis of open, laparoscopic and Robot-assisted Radical cystectomy.

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